CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 71 110.250000 4101.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 94 397.250000 14777.7000 37.2000
Subtotal (Total Children Is Unduplicated) 97 511.500000 18879.0000 36.9091
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 45.500000 3412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 18 27.000000 2025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 12 19.000000 1425.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 45 78.000000 4329.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 70 219.500000 14658.7500 66.7825
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 8 11.000000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 10 20.000000 300.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 7.000000 84.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 6.000000 431.7600 71.9600
TRAV-TRAVS-Travel by mile 6 304.000000 135.2500 0.4449
Subtotal (Total Children Is Unduplicated) 13 348.000000 951.0100 2.7328
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Total 1079.000000 34488.7600 31.9636
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Number of Children (Unduplicated) With at Least One Service 102
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Center 53
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 343 391.750000 17977.3500 17827.3500
D 12 14.500000 914.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 32 329.000000 1172.5000 1172.5000
422 343.750000 14424.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 809 1079.000000 34488.7600 18999.8500